Digital Tomosynthesis vs. Standard Mammography for Breast Cancer Screening

Recruiting at158 trial locations

Overseen by Etta Pisano

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Waitlist Available

Sponsor: ECOG-ACRIN Cancer Research Group

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This randomized phase III trial studies digital tomosynthesis mammography and digital mammography in screening patients for breast cancer. Screening for breast cancer with tomosynthesis mammography may be superior to digital mammography for breast cancer screening and may help reduce the need for additional imaging or treatment.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you are on hormone therapy, you may still be eligible to participate.

What data supports the idea that Digital Tomosynthesis vs. Standard Mammography for Breast Cancer Screening is an effective treatment?

The available research shows that Digital Breast Tomosynthesis (DBT) is more effective than standard mammography for breast cancer screening. Studies indicate that DBT has a higher cancer detection rate, meaning it finds more cases of cancer than standard mammography. Additionally, DBT results in fewer false alarms, which means fewer people are called back for additional tests when there is no cancer. This makes DBT a more reliable option for screening. ^{1 2 3 4 5}

What safety data exists for digital tomosynthesis and standard mammography in breast cancer screening?

The safety data for digital tomosynthesis (DBT) and standard mammography (DM) in breast cancer screening includes concerns about increased radiation exposure when using both DBT and DM together. However, using synthesised two-dimensional mammography (s2D) from DBT datasets can mitigate this issue by avoiding additional radiation. Studies have shown that DBT may have higher cancer detection rates and lower recall rates compared to 2D mammography alone. There is also evidence from a randomized trial indicating that DBT increases invasive cancer detection rates and reduces recall rates in higher-risk women. Overall, DBT appears to be a promising alternative with potential safety benefits when used with s2D. ^{1 4 6 7 8}

Is Digital Tomosynthesis Mammography a promising treatment compared to Standard Mammography for breast cancer screening?

Yes, Digital Tomosynthesis Mammography, also known as 3D Mammography, is a promising treatment for breast cancer screening. It has been shown to improve diagnostic accuracy and reduce recall rates compared to Standard Mammography. This means it can help doctors find breast cancer more accurately and reduce the number of times patients need to come back for additional tests. ^{2 4 9 10 11}

Research Team

Etta Pisano

Principal Investigator

ECOG-ACRIN Cancer Research Group

Eligibility Criteria

This trial is for women who are not pregnant or breastfeeding, have not had a mammogram in the last 11 months, and show no symptoms of breast disease. Women with dense breasts or postmenopausal women on hormone therapy or with family history/genetic risk for breast cancer may be eligible. Those with prior breast cancer or enhancements are excluded.

Inclusion Criteria

I don't need a diagnostic mammogram for any breast disease symptoms.

I plan to, or have scheduled, a mammogram.

Patients must not have had a screening mammogram within the last 11 months prior to date of randomization

Exclusion Criteria

Not applicable.

Treatment Details

Interventions

• Digital Mammography (Procedure)
• Digital Tomosynthesis Mammography (Procedure)

Trial Overview The study compares digital tomosynthesis mammography (3D imaging) and standard digital mammography (2D imaging) to see which is more effective for breast cancer screening and reducing unnecessary follow-up procedures.

Participant Groups

Group I: Arm B (digital tomosynthesis mammography) Experimental Treatment 2 Interventions

Patients undergo manufacturer-defined screening TM at baseline, 12, 24, 36, and 48 months if pre-menopausal or at baseline, 24, and 48 months if post-menopausal.

Group II: Arm A (digital mammography) Experimental Treatment 2 Interventions

Patients undergo bilateral screening DM with standard CC and MLO views at baseline, 12, 24, 36, and 48 months if pre-menopausal or at baseline, 24, and 48 months if post-menopausal.

Digital Mammography is already approved in Canada, Japan, China, Switzerland for the following indications:

Approved in Canada as Digital Mammography for:

• Breast cancer screening

Approved in Japan as Digital Mammography for:

• Breast cancer screening

Approved in China as Digital Mammography for:

• Breast cancer screening

Approved in Switzerland as Digital Mammography for:

• Breast cancer screening

Who Is Running the Clinical Trial?

ECOG-ACRIN Cancer Research Group

Lead Sponsor

Trials

122

Recruited

160,000+

Dr. Peter J. O'Dwyer

ECOG-ACRIN Cancer Research Group

Chief Executive Officer since 2012

MD from University of Pennsylvania

Dr. Mitchell D. Schnall

ECOG-ACRIN Cancer Research Group

Chief Medical Officer since 2012

MD, PhD from University of Pennsylvania

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Dr. Douglas R. Lowy

National Cancer Institute (NCI)

Chief Executive Officer since 2023

MD from New York University School of Medicine

Dr. Monica Bertagnolli

National Cancer Institute (NCI)

Chief Medical Officer since 2022

MD from Harvard Medical School

Canadian Cancer Trials Group (CCTG)

Collaborator

Trials

2

Recruited

109,000+

Findings from Research

In a study involving over 4.5 million women screened between 2015 and 2017, digital breast tomosynthesis (DBT) showed a modestly lower recall rate compared to 2D mammography, particularly benefiting younger women aged 40-44.

DBT was associated with a higher cancer detection rate and increased biopsy rates compared to 2D mammography, indicating its potential effectiveness in identifying breast cancer, although the impact on clinical outcomes is still uncertain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of Digital Breast Tomosynthesis for Breast Cancer Screening Among Women 40-64 Years Old. Richman, IB., Long, JB., Hoag, JR., et al.[2023]

Screening with 3D digital breast tomosynthesis (DBT) resulted in a 16.1% lower recall rate compared to 2D digital mammography (DM), indicating fewer patients were called back for additional testing, which can reduce anxiety and unnecessary procedures.

The overall cancer detection rate (CDR) was 28.6% higher for 3D DBT (6.3 cancers per 1000 patients) compared to 2D DM (4.9 per 1000), with a significant increase in the detection of invasive cancers, suggesting that 3D DBT is more effective in identifying breast cancers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. Greenberg, JS., Javitt, MC., Katzen, J., et al.[2016]

Digital breast tomosynthesis (DBT) combined with digital mammography (DM) shows sustainable improvements in breast cancer screening outcomes over four years, including a significant reduction in recall rates compared to DM alone (from 104 to 92 per 1000 screened).

The number of cancer cases detected per recalled patient increased with DBT screenings, indicating enhanced detection capabilities, while interval cancer rates decreased from 0.7 to 0.5 per 1000 women screened, suggesting improved safety and efficacy of the screening method.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography: Outcomes Analysis From 3 Years of Breast Cancer Screening. McDonald, ES., Oustimov, A., Weinstein, SP., et al.[2017]

In a study involving 238 cases of non-calcific, screen-detected mammographic abnormalities, digital breast tomosynthesis (DBT) using Siemens equipment showed a slightly higher diagnostic accuracy compared to supplementary mammographic views (SMVs), but the difference was not statistically significant.

Both DBT and SMVs demonstrated equivalent diagnostic accuracy for detecting benign and malignant cases, suggesting that DBT can be used effectively in place of SMVs in breast cancer screening programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical performance of Siemens digital breast tomosynthesis versus standard supplementary mammography for the assessment of screen-detected soft-tissue abnormalities: a multi-reader study. Whelehan, P., Heywang-Köbrunner, SH., Vinnicombe, SJ., et al.[2018]

In a study of 35,736 women screened over eight years, digital breast tomosynthesis (DBT) showed lower recall rates and higher rates of screen-detected breast cancer compared to standard digital mammography (DM), indicating improved efficacy in cancer detection.

The positive predictive values for DBT were higher than for DM, and while DBT detected more favorable tumor characteristics, there were no differences in interval cancer rates between the two screening methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening outcome for consecutive examinations with digital breast tomosynthesis versus standard digital mammography in a population-based screening program. Hovda, T., Brandal, SHB., Sebuødegård, S., et al.[2021]

Using digital breast tomosynthesis (DBT) combined with synthesized two-dimensional mammography (s2D) significantly improves cancer detection rates (CDR) by 35% compared to traditional digital mammography (DM) alone, while also reducing recall rates.

The combination of DBT and s2D leads to higher positive predictive values for recalls (PPV-1) and biopsies recommended (PPV-2), indicating better diagnostic accuracy without increasing biopsy rates, making it a safer and more effective screening option for breast cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis. Heywang-Köbrunner, SH., Jänsch, A., Hacker, A., et al.[2022]

Both 2-view and 1-view digital breast tomosynthesis (DBT) implementations showed similar effectiveness in detecting breast cancer, with no significant differences in sensitivity, specificity, or area under the curve (AUC) based on a study of 118 patient image sets evaluated by six observers.

The 1-view DBT method exposes patients to half the radiation dose compared to the 2-view method, suggesting it could be a safer option for breast cancer surveillance, although further research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of two-view versus single-view digital breast tomosynthesis and 2D-mammography in breast cancer surveillance imaging. Hadjipanteli, A., Polyviou, P., Kyriakopoulos, I., et al.[2023]

In a study involving 1227 women aged 40-49 with a family history of breast cancer, the addition of digital breast tomosynthesis (DBT) to 2D mammography did not significantly reduce recall rates, with false positive rates being similar for both methods (2.4% for 2D vs. 2.2% for 2D+DBT).

However, DBT showed a significant reduction in the number of women with abnormal reads who were not recalled after further review, suggesting that while it may not lower recall rates, it could improve the accuracy of readings over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women. Maxwell, AJ., Michell, M., Lim, YY., et al.[2022]

In a study involving 24,901 women aged 50 to 69, the combination of current reconstructed 2D images with digital breast tomosynthesis (DBT) showed similar cancer detection rates to standard full-field digital mammography (FFDM) plus DBT, indicating its effectiveness as a screening method.

The false-positive rates were also comparable between the two methods, suggesting that the current reconstructed 2D images can be safely used in routine clinical practice without increasing unnecessary anxiety for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Skaane, P., Bandos, AI., Eben, EB., et al.[2016]

Digital breast tomosynthesis (DBT) enhances breast cancer screening by improving both sensitivity and specificity compared to traditional 2D mammography, leading to better detection of cancers at earlier stages.

DBT eliminates the need for full-exposure 2D mammograms, suggesting it will become the standard method for breast cancer screening, potentially reducing recall rates and improving patient access to effective screening.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital breast tomosynthesis from concept to clinical care. Kopans, DB.[2016]

In a study of 17,955 screening mammograms, the combination of digital breast tomosynthesis (3D) with conventional mammography (2D) resulted in a significantly lower recall rate of 7.8%, compared to 12.3% for conventional 2D mammography, indicating improved efficiency in screening.

The lower recall rates were particularly notable for patients with asymmetries and calcifications, suggesting that 3D imaging enhances the detection process and reduces unnecessary follow-ups, while also maintaining a high cancer detection rate of 5.9 cancers per 1000 examinations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early clinical experience with digital breast tomosynthesis for screening mammography. Durand, MA., Haas, BM., Yao, X., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of Digital Breast Tomosynthesis for Breast Cancer Screening Among Women 40-64 Years Old. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography: Outcomes Analysis From 3 Years of Breast Cancer Screening. [2017]

4. England pubmed.ncbi.nlm.nih.gov

Clinical performance of Siemens digital breast tomosynthesis versus standard supplementary mammography for the assessment of screen-detected soft-tissue abnormalities: a multi-reader study. [2018]

5. Germany pubmed.ncbi.nlm.nih.gov

Screening outcome for consecutive examinations with digital breast tomosynthesis versus standard digital mammography in a population-based screening program. [2021]

6. Germany pubmed.ncbi.nlm.nih.gov

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Comparison of two-view versus single-view digital breast tomosynthesis and 2D-mammography in breast cancer surveillance imaging. [2023]

8. Ireland pubmed.ncbi.nlm.nih.gov

A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. [2016]

10. United States pubmed.ncbi.nlm.nih.gov

Digital breast tomosynthesis from concept to clinical care. [2016]

11. United States pubmed.ncbi.nlm.nih.gov

Early clinical experience with digital breast tomosynthesis for screening mammography. [2022]